Tocilizumab Utilization for Coronavirus Disease 2019: A Case Series

Background The deterioration of patients with coronavirus disease 2019 (COVID-19) has been hypothesized to be due to cytokine release syndrome including interleukin-6 (IL-6) Tocilizumab (TCZ) is an IL-6 inhibitor that may be a potential therapy for COVID-19 Methods Patients hospitalized for COVID-19 and treated with TCZ between March 1, 2020, and March 26, 2020, at an academic medical center in New York City were described Patients were categorized as severe illness or critical illness based on previously described definitions Outcomes assessed included respiratory status improvement, laboratory values, discharge, or death Results A total of 12 patients were included in this case series Ten patients were classified as critical and 2 as severe Eight (n = 6 critical and n = 2 severe) patients had improvements in respiratory symptoms after receiving TCZ and were discharged, but 4 patients expired despite receiving therapy All patients had an elevation in IL-6 and C-reactive protein levels before TCZ treatment After TCZ treatment, there was a significant decrease in C-reactive protein levels (P = 0 002) and an increase in aspartate aminotransferase (P = 0 18) and alanine aminotransferase (P = 0 006) levels Patients who received TCZ treatment later in their hospitalization course had a poor outcome Conclusions Tocilizumab may play a role in treating patients with COVID-19 with elevated IL-6 levels, who are classified as severely ill and treated early in their disease course The risks of adverse events and economic burdens should also be evaluated Correspondence to: Elizabeth M Gavioli, PharmD, BCPS, BCGP, Assistant Professor of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, 1 University Plaza, Brooklyn, NY 11201 E-mail: elizabeth gavioli@liu edu;or Jaclyn A Cusumano, PharmD, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, 1 University Plaza, Brooklyn, NY 11201 E-mail: jaclyn cusumano@liu edu The authors have no funding or conflicts of interest to disclose This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections Copyright © 2020 Wolters Kluwer Health, Inc All rights reserved